An Opinion Piece by Peter Rousmaniere
The models for research which the Workers Compensation Research Institute has relied on since its founding have been right for its time. It now needs an additional model. That is why, in my view, WRCI’s extensive reporting on the state of affairs is nice to read but no longer in sum a page-turner. The WCRI evolved historically as the place to go to understand urgent issues. Here I describe the urgent issue it deserves to address going forward.
The WCRI’s primary contribution is not, in fact, informing the industry. It continues to do that well. Others do that as well. Above all, it contributes uniquely by getting people to think. Its conference attendees have their minds ignited and they bring that fire back to their colleagues. Analysis is its product; inspiration is its brand.
Medical care has been poorly understood and expensive and it has demanded great attention. The WCRI is the premier think tank on medical care for a broad constituency of claims payers, employers, state agencies and legislators.
This constituency has to cope with unruly treatment, a medical community recalcitrant to change, and rising costs. Witness the widespread and sustained investment in medical controls – bill review, utilization review, provider networks, drug spending, and treatment guidelines.
Where are we now? The levers of medical care control are pretty well understood and can be applied with confidence. They demand constant attention. Information systems and laws of some states could improve. But further improvements are incremental.
Credit WRCI for being the forum for industry discussion about medical treatment. It has Inspired others to research medical care. But its focus today is on helping with increments in contrast with game changes in insight. Its unique distinction will fade.
A frank assessment would observe that it has under-invested in illuminating the performance goals of the workers’ comp system. Controlling medical care is a means to an end, not the end itself.
What is urgent today? That which has justified many state and private sector initiatives for several decades: restoring the injured worker’s economic position in her often-fragile world.
The five year-running Workers Compensation Benchmark Study, managed by Rising Medical Solutions, has asked what matters most. Some 1,700 claims executives have through surveys voted that an employee’s return to the same or better pre-injury functional capabilities is the most valued claims outcome.
The WCRI’s primary constituents would welcome better understanding of return to work. That includes research into the determinants of successful and failed return to work. And it includes metrics.
We lack a nuanced understanding of return to work. Unsurprisingly. it is vulnerable to moral hazard. The employee may decide that she is better off leaving her employer. The employer might use the workers’ comp system as an outplacement solution for undesirable workers. The claims adjuster, assigned too many claims, may want to relegate many lost time claims to low-grade maintenance status rather than put the effort into solving return to work puzzles. These incentives add to the need of deeper insight into return to work performance.
The National Council on Compensation Insurance has published a few studies of the duration of total temporary disability. It has a lot more insight it can share. But to deeply understand return to work, one has to know a lot about the medical care delivered. This is where the WCRI excels.
Duration of disability guidelines, published by ODG/MCG and MDGuidelines, are extensively used by claims teams. Their popularity proves that claims payers are vitally interested in influencing duration. These two companies optimize their databases for managing individual claims. They are not designed to look retrospectively, target and manage duration and return to work for a population of work injuries.
The WCRI currently reports some return to work and disability duration in its occasional worker survey reports. But it appears never have used its access to a massive claims database from many states to delve into return to work.
Three reasons for measuring return to work stand out. All align with the WCRI’s distinctive role in helping us think.
One is that many people believe that long term disability is not a fated outcome but to a large extent the result of an avoidable failure to return to work in a timely manner. Hence, the best way to reduce long term disability and earnings loss is to optimize ways to achieve return to work in a relatively short time. This proposition needs to be studied.
A second reason is that the workers’ comp industry has built up a lot of resources expressly designed to facilitate timely return to work and shortened duration of disability. If that is so, one might ask why the industry does not measure actual return to work performance and disability duration.
Third, consider the public’s perception of the workers’ comp system. Our system is expected to take care of work injuries as best we can. A singularly impressive cure is bringing injured workers back to earning capacity. Would dedicated research by the WCRI not calm public skepticism about what we do?
Some say that the return to work performance of a large population of claims cannot be reliably measured. But a careful, persistent effort to resolve problems in analysis can lead to reliable findings.
Here is where the WCRI’s future in leadership can be found.